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Organ Failure and Transplants

Chronic Kidney (Renal) Failure

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of end stage kidney (renal) failure presenting as chronic irreversible failure of both kidneys to function, requiring either regular renal dialysis or a renal transplantation.

Diagnosis Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of irreversible chronic kidney (renal) failure.

Chronic Liver Failure

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of end stage liver failure with any of the following symptoms:

  • Permanent jaundice
  • Ascites
  • Encephalopathy

Diagnosis Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of irreversible chronic liver failure.

End Stage Chronic Lung Disease

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of end stage chronic lung disease with the need for permanent supplementary oxygen to treat the lung disease and with at least one of the following:

  • FEV 1 test results of consistently less than 1 litre
  • Permanent impairment of at least 25 percent of whole person function
  • The total and irreversible inability to perform at least one of the activities of daily living without the help of another adult

Diagnosis Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of irreversible chronic lung failure.

Intensive Care Treatment

Full Critical Illness Benefit Criteria

An illness or injury that results in either:

  • Continuous mechanical ventilation by tracheal intubation for at least 3 days in a row
  • Admission to the intensive care ward of a registered medical hospital for at least 5 days in a row on the recommendation of an appropriate specialist

We exclude intensive care treatment that’s needed because of alcohol or drug abuse.

Organ Transplant

Full Critical Illness Benefit Criteria

Undergoing human-to-human organ transplant from a donor, or being approved for human-to-human organ transplant from a donor and placed on a recognised New Zealand or Australian organ transplant waiting list for transplant of one or more of the following organs:

  • Kidney
  • Heart
  • Lung
  • Liver (including partial liver)
  • Pancreas
  • Small bowel

We also cover the transplant of bone marrow.

We exclude the transplant of all other organs or parts of organs (except partial liver transplants) and any other tissue or cell transplant.

Pneumonectomy

Full Critical Illness Benefit Criteria

Undergoing surgery to remove an entire lung where an appropriate specialist considers that it’s medically necessary and the most suitable treatment.

Severe Diabetes

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of diabetes mellitus confirming at least one of the following:

  • Severe diabetic retinopathy resulting in visual acuity less than 6/36 in each eye after correction
  • Severe diabetic neuropathy causing motor impairment, autonomic impairment or both
  • Diabetic gangrene leading to surgical intervention
  • Severe diabetic nephropathy that causes chronic irreversible renal impairment, as measured by a corrected creatinine clearance of 29ml/min or less (CKD stage 4 or 5, International Chronic Kidney Disease classification)

Severe Inflammatory Bowel Disease

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of Crohn’s disease, ulcerative colitis or both, that has failed conventional medical intervention and needs either:

  • Indefinite immunosuppressive therapy
  • Surgical removal of the entire large bowel (colon and rectum)